Use of magnetic resonance imaging in severe pediatric traumatic brain injury: Assessment of current practice

Peter A. Ferrazzano, Bedda L. Rosario, Stephen R. Wisniewski, Nadeem I. Shaf, Heather M. Siefkes, Darryl K Miles, Andrew L. Alexander, Michael J. Bell, Ajit Sarnaik, Shruti Agrawal, Sarah Mahoney, Deepak Gupta, John Beca, Laura Loftis, Kevin Morris, Lauren Piper, Anthony Slater, Karen Walson, Tellen Bennett, Todd KilbaughA. M. Iqbal O'Meara, Nathan Dean, Ranjit S. Chima, Katherine Biagas, Enno Wildschut, Mark Peters, Kerri LaRovere, Joan Balcells, Courtney Robertson, Shira Gertz, Akash Deep, Sian Cooper, Mark Wainwright, Sarah Murphy, John Kuluz, Warwick Butt, Nicole O'Brien, Neal Thomas, Sandra Buttram, Simon Erickson, J. Mahil Samuel, Rachel Agbeko, Richard Edwards, Kesava Ananth Ramakrishnan, Margaret Winkler, Santiago Borasino, Joanne Natale, Christopher Giza, Mary Hilfiker, David Shellington, Anthony Figaji, Elizabeth Newell, Edward Truemper, Robert Clark, Kit Newth, Nadeem Shafi, Michelle Schober, Jerry Zimmerman, Jose Pineda

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

OBJECTIVE There is no consensus on the optimal timing and specific brain MRI sequences in the evaluation and management of severe pediatric traumatic brain injury (TBI), and information on current practices is lacking. The authors performed a survey of MRI practices among sites participating in a multicenter study of severe pediatric TBI to provide information for designing future clinical trials using MRI to assess brain injury after severe pediatric TBI. METHODS Information on current imaging practices and resources was collected from 27 institutions participating in the Approaches and Decisions after Pediatric TBI Trial. Multiple-choice questions addressed the percentage of patients with TBI who have MRI studies, timing of MRI, MRI sequences used to investigate TBI, as well as the magnetic feld strength of MR scanners used at the participating institutions and use of standardized MRI protocols for imaging after severe pediatric TBI. RESULTS Overall, the reported use of MRI in pediatric patients with severe TBI at participating sites was high, with 40% of sites indicating that they obtain MRI studies in > 95% of this patient population. Differences were observed in the frequency of MRI use between US and international sites, with the US sites obtaining MRI in a higher proportion of their pediatric patients with severe TBI (94% of US vs 44% of international sites reported MRI in at least 70% of patients with severe TBI). The reported timing and composition of MRI studies was highly variable across sites. Sixty percent of sites reported typically obtaining an MRI study within the first 7 days postinjury, with the remainder of responses distributed throughout the first 30-day postinjury period. Responses indicated that MRI sequences sensitive for diffuse axonal injury and ischemia are frequently obtained in patients with TBI, whereas perfusion imaging and spectroscopy techniques are less common. CONCLUSIONS Results from this survey suggest that despite the lack of consensus or guidelines, MRI is commonly obtained during the acute clinical setting after severe pediatric TBI. The variation in MRI practices highlights the need for additional studies to determine the utility, optimal timing, and composition of clinical MRI studies after TBI. The information in this survey describes current clinical MRI practices in children with severe TBI and identifies important challenges and objectives that should be considered when designing future studies.

Original languageEnglish (US)
Pages (from-to)471-479
Number of pages9
JournalJournal of Neurosurgery: Pediatrics
Volume23
Issue number4
DOIs
StatePublished - Apr 1 2019

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Keywords

  • Magnetic resonance imaging
  • Pediatric traumatic brain injury
  • Survey
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Ferrazzano, P. A., Rosario, B. L., Wisniewski, S. R., Shaf, N. I., Siefkes, H. M., Miles, D. K., Alexander, A. L., Bell, M. J., Sarnaik, A., Agrawal, S., Mahoney, S., Gupta, D., Beca, J., Loftis, L., Morris, K., Piper, L., Slater, A., Walson, K., Bennett, T., ... Pineda, J. (2019). Use of magnetic resonance imaging in severe pediatric traumatic brain injury: Assessment of current practice. Journal of Neurosurgery: Pediatrics, 23(4), 471-479. https://doi.org/10.3171/2018.10.PEDS18374